My Nose and I: A Story Of Skin Cancer

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“Its skin cancer.” *

I am on the phone with someone from my new dermatologist’s office. Her statement was not what I expected. The small sliver of skin that had been removed from my nose was nothing more than a very slight dry patch. It wasn’t noticeable, I only felt it when I put cream on my face at night. Skin cancer?

“Ms. Houghton? You still there?” Of course I’m still here. Where would I go after you tell me this news? The phone seems glued to my hand and I’m in a slight state of shock.

“Ms. Houghton? Hold on a second, let me check when we can fit you in for surgery.” Pause in the call. I hear people talking and laughing in the background, normal everyday office chatter. It seems almost surreal to hear them.

“We can schedule you for surgery next week. When is a good time for you?” I almost laugh. To me the expression “good time” sounds strange all of a sudden. It denotes something that is fun. Call me crazy, but I cannot think of surgery on my nose as fun.

“Is it basal cell?” I ask, fully expecting it to be. It is, after all, the most common and most curable form of skin cancer. I have only read about two forms of skin cancer, basal cell and the most dreaded form, melanoma.

“No, it is squamous cell.” What the hell is squamous cell, I think?

I hesitate. My palms are sweating and I suddenly feel as if I want to throw up.

“Ms. Houghton? When would you like surgery scheduled?” Never. But I answer:

“What days do you have? I’d like it done as soon as possible, of course.”

I hear her shuffle some papers as she flips through an appointment book and then she tells me Wednesday of next week. Is morning okay for me? I say yes and we make the date for ten AM sharp. We say polite good-byes and after I hang up the phone I almost break a leg racing upstairs to my office computer to research the words “squamous cell.”

People who write for a living are very good when it comes to research. We are quite thorough searching through everything that pertains to what we need. I always counted it as a blessing that I enjoy researching information for articles and stories. I read everything.

Today, however, that ability is a curse.

I go to WebMD first, key in skin cancer, and am so nervous, I read the first paragraph three times. Squamous cell is the second most common form of skin cancer, it says, slightly more dangerous than basal cell. It is curable however. Of course, good researcher that I am, I have to read further just to check out the worst case scenario of what having squamous cell can mean. Still that word “curable” kept reassuring me: I’m going to be okay.

I love hot weather and the sunshine, (I’m a SoCal girl after all), but I have never been one of those people who baste themselves in the sun. I always thought this was to my benefit. My doctor explains that the skin cancer is more than likely the result of having been sunburned as a child. This sparks a memory. My grandparents had a summer house. I remember my grandmother telling me I was so fair as a child that I would get blisters on my nose and cheeks just walking the short path from her house to the beach.

Because of the visibility of where the scar will be, my dermatologist schedules an appointment for me with Dr. Hall, a prominent plastic surgeon who specializes in minimal facial scarring. I am re-checked by him and it is confirmed. I have squamous cell. He is calm and very understanding. He tells me that there are two ways I can go with this, I can use a form of chemotherapy in cream form and have the site checked regularly, (a sort of wait-and-see approach), or I can have surgery and he will “close up the incision and then do a scar revision on the area after a few months of healing.” I opt for the surgery. My dermatologist, who specializes in skin cancer, will do the operation, and the plastic surgeon will then close it up. We are set.

My operation is scheduled at a hospital that specializes in a surgery known as MOHS, which is micrographic surgery. This, I learned from the internet and my new doctor, is the most progressive surgery for skin cancer. It saves as much of the healthy skin as possible. Instead of the usual procedure of cutting deeply into a site, taking out healthy tissue as well as the cancerous part, the MOHS procedure begins by slicing very thin layers of skin, one at a time, and checking them under a microscope for cancer cells. The patient waits in the operating area or returns to the waiting room, as the doctor takes the sample to be checked, then comes back to remove another thin layer of skin for the microscope. When no more malignant cells appear and clear samples are seen on the slides, the operation is over. You can be in the hospital for two to six hours, however, depending on how long it takes before there are clear skin samples. I write this in layman’s terms but, basically, that’s it.

Hospitals today look more like fancy hotels than places where operations take place. As my husband and I enter the lobby, I am reminded of entering the grand foyer of the Ritz-Carleton in Sarasota, Florida. We are sent to the third floor where “everything-you-ever-wanted-done-to-your-skin” is situated. Not only is this the floor for MOHS patients, it is also the place for the newest in “age-defying mini-operations.” Corrective skin surgery, therma-cool, (the procedure that tightens the collagen in your skin to get rid of sagging), processes that take brown spots out of your skin. You name it, you got it. I find myself wishing I was here for one of the age-defying fixes.

The majority of the people here, in the decorator-touch waiting area, are here for the same thing I am. We are members of a select club to which we had not wanted to be selected. Some spouses are there also to give their support. My husband, Alan, is one of theses supporters. There are comfortable chairs and couches placed around a large TV, a table which holds fresh coffee, assorted teas, juices, bagels, muffins, and pastries. These are supplied by the hospital “for your pleasure.”

A sign informs us that, if we are still here at one o’clock, there will be a lunch provided for us. It is now eight in the morning. I hope I’m not here for lunch.

I take a cup of coffee and look around at my fellow MOHS friends. I see something a little surprising. They are thirty to forty years older than I am. I am a little startled. This was found on me so young. Is this something to worry about? Then I decide no, it’s just that people are more aware today about skin cancer. Today a person in their seventies is as likely to get checked for skin cancer as a person in their twenties, thirties or forties.

A nurse comes to get me and I am led to a small operating room. There I am seated on a reclining chair and draped with a white surgical sheet. Dr. Rogascefsky, my dermatologist, comes in and delicately injects an anesthetic into the right side of my nose. She is very gentle and I feel only a slight sting from the liquid in the needle.

I am glad she is doing the surgery. The first dermatologist I went to was very gruff and handled my face as if it was a piece of dough. He did not specialize in skin cancer surgery and became impatient when I asked questions. Not being comfortable with him, I did my research (of course) and found Dr. Rogaschefsky who is kind and understanding. She smiles, tells me to relax and leaves the room. I am alone with the music playing on the Bose sound system and my thoughts.

Let me say something here about my nose. I have always liked it. It has never given me a problem. I never worried about it being too fat like other parts of my body or not looking good in jeans. My nose has always been pretty good for me and, except for some seasonal allergies, I really never gave it much thought. It is a perfect match for my face, not big or small. Now, in a little while, I’m going to have someone, albeit someone I trust, slice thin pieces off of it. I am scared.

Dr. Rogascefsky is about seven months pregnant and, as she leans over me, I feel her belly pressed against my shoulder. It is a strangely comforting feeling. She pokes the tip of a scalpel to the side of my nose and I feel nothing. Thank God! I am numb. She tells me to relax, tilts my head and begins the operation. With my eyes closed against the bright operating room light, I feel nothing as she begins the operation, but I hear everything. I even hear the sound of the scalpel making the initial cut, a soft slicing sound, as she is removing the first thin sample. And I smell my own blood. This is a little disturbing. She takes two samples, bandages the area, and sends me to the waiting room.

I sit in the waiting area, sipping orange juice, and forty five minutes later, I am brought back to the operating room. The doctor tells me the second slide she took is free and clear. There is now no new trace of squamous cell. I can go to Dr. Hall for the “closing-up.” My wound is packed heavily with gauze and my husband drives me to Dr. Hall’s office .

At the plastic surgeon’s office I am again given a local anesthetic. I smell flesh burning as he cauterizes the blood vessels and feel a tug as he pulls the skin on my cheek over to close the wound on my nose. He uses minute stitches and I try to keep track of how many but I lose count. I am sent home with instructions to ice the area and rest. I can take extra strength Tylenol for any discomfort.

Surprisingly I have very little pain. As the numbness wears off it feels like deep paper cuts, stinging but not painful. I take the Tylenol and doze off and on with an ice pack on my nose. Two days later I am back writing, the only difference is I can’t wear my “computer glasses” for very long because it puts pressure on the sore area.

After a week I go back to see Dr. Rogascefsky who checks the wound, says everything is clear, and comments on Dr. Hall’s work as excellent. She shows my nose to another doctor who says I was lucky to get Dr. Hall.

“Your nose looks great. This is as good as it gets,” he says admiringly.

I feel as if my nose has hit celebrity status.

I go see Dr. Hall two days later. He removes the bandage and stitches, then hands me a mirror. It doesn’t look as bad as I thought it would but it does looks as if someone had put a dime’s worth of putty on the side of my nose. Dr. Hall tells me that it will take from three to six months for all the swelling to go down. Also he has pulled over a little extra skin because it is better to have more skin to work with for scar revision. He is confident and reassuring. This is a man who deals with major trauma victims. Working on my nose is a simple thing for him.

I am to be checked by Dr. Hall every three weeks for six months. During the sixth month I am scheduled for a scar revision.

Fast forward six months: Ten days after I have the scar revision done, and the bandages are removed, I am amazed by the difference. The putty dot is gone, my nose looks like its old self except for a little swelling and faint stitch marks, which will pretty much fade in time. For now the marks can be covered by light make-up.

Again I am told that the swelling will take at least six months to go down and, if I am still not happy with my nose, I can have more revision done. I am given a cortisone cream to gently massage into my nose to reduce swelling, and told to return in three weeks.

That was several years ago. I never had the second scar revision; I didn’t need it. My nose and I are back to normal. The scar is slight but I feel it when I wash my face or put on make-up. I can still see it a little too. That may be because I know that it is there. Sometimes it makes its presence known by throbbing a little. But these are little things.

I have to say that it looks damned good.

I do know that my experience with the two doctors who treated me was a good experience. They treated me with kindness and respect and both were experts in skin surgery. I’m glad I found both of them. I know of several people whose experiences were not pleasant and who had gone to doctors who were not well versed in treating cancer of the skin.

I went for six month check-ups for the first year following surgery. Now I go once a year. I’m making my guy go for check-ups too. Its good for both of us.

The episode with skin cancer did make an impression on me. Even though I had one of the most curable cancers, it is, after all, still cancer. That word alone strikes as much fear in the human mind today as the word leprosy did in the past. That word also lets me know that I am not immortal and it tells this very mortal person that she is indeed lucky; that a tiny scar is a small price to pay to be healthy again.

*May is Skin Cancer Awareness Month. Know the signs of skin cancer and get checked. Remember, skin cancer, when caught early, is highly curable. You don’t have to be someone who lies for hours in the sun to fall victim to sun damage. Please get checked for skin cancer every year and be ‘sun-careful’. Your life is worth it.~ Kristen Houghton